First Trimester

Abortion Procedures First Trimester

1st through 12th week

In most cases, you will have a choice between medical or surgical abortion procedure during the first trimester. Before seeking a medical abortion procedure, it is recommended that you obtain a sonogram to determine if the pregnancy is viable (uterine, non-ectopic pregnancy) and for accurate pregnancy dating or gestation. Medical abortions are only available up through nine weeks gestation. Non-Surgical Abortions Non-Surgical Abortions are NOT performed after the First Trimester. RU-486 (The Abortion Pill); Mifeprex, For use within 4 to 7 weeks after LMP This method should not be used if it has been more than 7 weeks since your last period. It is NOT the same as the “Morning After Pill”. This procedure is a combination of drugs.

The first is Mifepristone, an artificial steroid that blocks the production of progesterone, a hormone needed to sustain pregnancy (progesterone causes the lining of the womb to thicken with blood, providing necessary nutrients for the developing fetus). Mifepristone causes the placenta to separate from the endometrium. It also softens the cervix and causes uterine contractions. The second chemical is a prostaglandin, usually Misoprostol or Cytotec, taken orally or inserted vaginally. This chemical increases uterine contractions to expel the embryo and the placenta (similar to a spontaneous abortion or miscarriage). This may occur in the clinic or may take up to 2 weeks in some cases. Some clinics may have you stay for 4 hours after Misoprostol is given, because if serious side effects occur, most usually occur in this time period and can then be treated. Some clinics may have you take Misoprostol at home and then the pregnancy will end sometimes 2-4 weeks later. Overall, this procedure requires several DR visits; the first for a medical history; the second for dispensing Mifepristone, the third for dispensing Misoprostol and the fourth to ensure the womb is completely empty. In some cases, when the womb retains either the embryo or part of the placenta, another visit is required for surgical removal of the same.

The drugs were developed by a French pharmaceutical company, Roussel-Uclaf (hence, the ‘RU’, and the term “French Abortion Pill”). The use of Misoprostol for this purpose has not been approved by the FDA. Effectiveness of Oral Mifepristone and Oral Misoprostol 2 Pregnancy length Effectiveness Up to 6 weeks 96% to 98% 6 to 7 weeks 91% to 95% Over 7 weeks 85% or less Side effects include heavy bleeding, headache, diarrhea, nausea, vomiting fever and cramping. Methotrexate and Vaginal Misoprostol. Used within 49 days (7 weeks) of the first day of the last period. This procedure is similar to the RU-486 but is administered through an intramuscular injection instead of a pill. This method may take up to 4 weeks for abortion to occur. Methotrexate is given as a needle at the doctor’s office. The woman then uses Misoprostol vaginally at home a few days later. She must visit the doctor about a week after the Methotrexate is given.

Methotrexate halts the implantation process that occurs during the first few weeks after conception. A vaginal ultrasound exam is done to confirm that abortion has occurred. If abortion has not occurred, another dose of Misoprostol is given. The most common side effects of a dose include: nausea, diarrhea, cramping and/or sores in the mouth, vomiting, headaches, dizziness, sleeplessness, anemia, bone marrow depression, liver disease and/or vaginal bleeding. Vaginal Misoprostol (alone) Used within 56 days (8 weeks) of the first day of the last period. This method uses only misoprostol, given vaginally.

Side Effects

Side effects can be worse with this procedure than with other methods, and it is less effective. Surgical Abortions: First Trimester Syringe Abortion Performed as early as eight days after conception. Utilizing ultrasound and a hand-held syringe rather than a vacuum pump for the removal of the fetus as early as eight (8) days after conception – takes only two (2) minutes and was pioneered by Houston, TX ‘ Planned Parenthood “medical director” Jerry Edwards. Suction Aspiration (Suction) or Vacuum Curettage Performed 6 – 12 weeks gestation This surgical abortion is done early in the pregnancy up until 12 weeks after the woman’s last menstrual period. Your abortion provider may administer medication and misoprostol to prepare for the procedure. The cervical muscle is stretched with dilators (metal rods) until the opening is wide enough to allow the abortion instruments to pass into the uterus. A high-powered vacuum is attached to tubing (a cannula) that is inserted into the uterus and the fetus is suctioned out.

In this method, a curette (a loop-shaped knife) may be used to scrape any remaining fetal parts out of the uterus to avoid further complications. Uterine hemorrhage and infection can result if fetal or placental tissue isn’t fully removed. Side effects include cramping, nausea, sweating and dizziness. More severe side effects include blood clots, damage to the cervix or uterus, infection caused by an incomplete procedure. Dilation & Curettage (D&C) Performed within 6 to 15 weeks gestation In this procedure, the cervix is opened with dilators (metal rods) or laminaria (thin sticks derived from plants/seaweed) are inserted several hours before the procedure.

The laminaria gradually dilates the cervix by soaking up fluid and swelling. After dilation, a curette, or loop-shaped knife, is inserted into the uterus to dissect the fetus and scrape the uterine lining to detach the placenta. All fetal parts and membranes are then scraped out of the woman’s body. Side effects include cramping, nausea, sweating and dizziness. More severe side effects include blood clots, damage to the cervix or uterus, infection caused by an incomplete procedure.

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